Pre-employment transition services for students with disabilities: A scoping review.

BACKGROUND: Students with disabilities often experience numerous challenges in terms of finding employment. Given the important role of vocational rehabilitation counselors in supporting employment activities for these students, a need exists for identifying effective strategies that increase employment outcomes for this population. OBJECTIVE: The objective of this scoping review is to examine and describe successful research- based interventions on pre-employment transition services for students with disabilities that can be used by vocational rehabilitation counselors. METHODS: The search strategy examined literature from 1998 through 2017 focused on vocational rehabilitation counselors, students with disabilities, and elements related to pre-employment transition services. Articles included American, European, and Australian literature published in English. RESULTS: This review identified a number of research-based interventions that support employment outcomes for students with disabilities. CONCLUSIONS: The research-based interventions identified in this scoping review can help vocational rehabilitation counselors consider effective strategies for increasing employment outcomes for students with disabilities.

Hearing Status and Aural Rehabilitative Profile of 878 Patients With Sporadic Vestibular Schwannoma.

OBJECTIVES/HYPOTHESIS: To examine the hearing status and aural rehabilitative profile in a national cohort of patients with sporadic vestibular schwannoma (VS). STUDY DESIGN: Cross-sectional survey METHODS: A cross-sectional survey of Acoustic Neuroma Association members diagnosed with sporadic VS was performed from February 2017 through January 2019. Self-reported results were used to determine the aural rehabilitative profile of respondents. RESULTS: Among survey respondents, 62.2% (546/878) were not using any hearing-assistive device at time of survey. For the 37.8% (332/878) that were utilizing hearing-assistive devices, 32.8% (109/332) reported using a behind-the-ear hearing aid, 23.8% (79/332) used a contralateral routing of signal (CROS) hearing aid, and 21.7% (72/332) used a bone conduction device. Notably, 41.9% (278/663) of patients who previously underwent tumor treatment reported utilizing a hearing rehabilitation device at some point during VS management compared to 27.0% (58/215) of those undergoing observation with serial imaging (P < .001). Of 275 patients with functional hearing in the ipsilateral ear, 26.5% (73/275) reported having used at least one type of hearing device; 24.0% (66/275) reported use of a conventional hearing aid, 0.7% (2/275) a CROS aid, and 0.4% (1/275) a bone conduction device. Among respondents reporting ipsilateral nonfunctional hearing, 44.9% (258/575) reported having used at least one type of hearing device; 13.0% (75/575) a CROS aid, and 12.3% (71/575) a bone conduction device. CONCLUSIONS: Even among a cohort with presumably elevated literacy surrounding hearing rehabilitation options, few patients with a history of unilateral vestibular schwannoma ultimately use hearing assistive devices long-term, suggesting that most patients sufficiently adjust to unilateral hearing loss or are unsatisfied with the benefits achieved with current device options. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:1378-1381, 2021.

Evolution in Management Trends of Sporadic Vestibular Schwannoma in the United States Over the Last Half-century.

OBJECTIVE: Limited data currently characterize management trends of sporadic vestibular schwannoma (VS) in the United States over recent decades. Serving as the primary patient support organization in the United States, the Acoustic Neuroma Association (ANA) facilitates amalgamation of data from patients treated from 1970 through January 2019. The primary objective of the current study was to characterize the evolution in the management of sporadic VS among ANA survey respondents treated over the last half-century. STUDY DESIGN/INTERVENTION: Cross-sectional survey. SETTING/PATIENTS: ANA survey respondents diagnosed with sporadic VS. MAIN OUTCOME MEASURES: Trends in rates of microsurgery, radiosurgery, and observation from 1970 to 2019. RESULTS: Among 953 patients with VS responding during the study period, 876 (92%) were included. Subjects reported the following management strategies: 220 observation (25%), 454 microsurgery (52%), and 193 radiosurgery (22%). The rate of microsurgery decreased from 86-88% from 1970 to 2000 to 44% in the last decade. The proportion of VS observed increased from 7% of all tumors in the 1990s, to 14% in the 2000s, to 33% in the 2010s. The rate of radiosurgery has increased to 28% in the last decades compared with 7% in the 1990s. The rate of subtotal resection in tumors > 2 cm increased from 34% in the 2000s to 60% in the 2010s (p = 0.0011). CONCLUSIONS: Overall, these data support a progression toward fewer patients treated with microsurgery in recent decades. Radiosurgery and observation became increasingly more common after the turn of the century, possibly due to better detection of small and asymptomatic tumors and a greater understanding of the natural history of disease.

Regional variation in vestibular schwannoma management and patient support group participation across the United States.

PURPOSE: The Acoustic Neuroma Association (ANA) represents the largest existing patient support organization for those diagnosed with vestibular schwannoma (VS) in the United States. Yet, the degree to which the ANA is actually utilized across the country is unknown. Moreover, evidence suggests that there may exist significant regional variation in management practices of VS across the United States. MATERIALS AND METHODS: Patient participation in the ANA by state and geographical region, as well as their management approach, was reviewed through a cross-sectional survey performed from February 2017 through January 2019, patients diagnosed with sporadic VS. RESULTS: Among 878 patients studied, the District of Columbia had the largest proportion of ANA patients relative to state population (0.85 per 100,000 persons), followed by New Hampshire (0.74), Maine (0.60), and New Jersey (0.42). Comparatively, Mississippi (0.03), Hawaii (0.07), and Rhode Island (0.09) harbored significantly lower participation rates (p = 0.001). Significant treatment variations were observed across the United States: in Maine, Iowa, Missouri, Kansas, and New Hampshire, an average of 73% (range, 70-75) of patients underwent microsurgery, whereas only 24% (range, 0-35) of patients in Colorado, New York, Massachusetts, Connecticut, and West Virginia underwent microsurgery (p < 0.001). After controlling for patient age and tumor size, patients were significantly more likely to undergo a retrosigmoid approach than the translabyrinthine approach for medium- to large-sized tumors in the Northeast (OR = 4.18; p = 0.001) and Western United States (OR = 2.94; p = 0.009). CONCLUSIONS: Large regional variation exists surrounding patient participation in the ANA as well as management practices across the United States.

The development of writing skills in 4-year-old children with and without specific language impairment.

Research shows that many preschool children with specific language impairment (SLI) have difficulty acquiring literacy skills including phonological awareness, print concepts, and alphabet knowledge. Limited research suggests that preschool children with SLI also have difficulty with emergent writing tasks such as name writing and word writing. In typically developing children, research indicates that emergent writing skills are acquired in a developmental sequence: (1) linearity, (2) segmentation, (3) simple characters, (4) left-right orientation, (5) complex characters, (6) random letters, and (7) invented spelling. This study compared the emergent writing skills of 4-year-old children with SLI (n = 22) to their age- and gender-matched peers (n = 22). Results indicated that children with SLI demonstrate difficulty with a variety of writing tasks, including letter writing, name writing, word writing, and sentence writing when compared to their typically-developing peers. Children with SLI followed the same developmental sequence in acquiring writing skills as their typically-developing peers.

Joint attention interventions for children with autism spectrum disorder: a systematic review and meta-analysis.

BACKGROUND: A core social-communication deficit in children with autism spectrum disorder (ASD) is limited joint attention behaviours-important in the diagnosis of ASD and shown to be a powerful predictor of later language ability. Various interventions have been used to train joint attention skills in children with ASD. However, it is unclear which participant, intervention and interventionist factors yield more positive results. AIMS: The purpose of this systematic review and meta-analysis was to provide a quantitative assessment of the effectiveness of joint attention interventions aimed at improving joint attention abilities in children with ASD. METHODS & PROCEDURES: The researchers searched six databases for studies meeting the inclusion criteria at two levels: title/abstract and full-text stages. Two independent coders completed data extraction using a coding manual and form developed specifically for this research study. Meta-analysis procedures were used to determine the overall effects of several comparisons including treatment type, treatment administrator, intervention characteristics and follow-up. MAIN CONTRIBUTION: Fifteen randomized experimental studies met inclusion criteria. All comparisons resulted in statistically significant effects, though overlapping confidence intervals suggest that none of the comparisons were statistically different from each other. Specifically, treatment administrator, dosage and design (control or comparison, etc.) characteristics of the studies do not appear to produce significantly different effects. CONCLUSIONS & IMPLICATIONS: The results of this meta-analysis provide strong support for explicit joint attention interventions for young children with ASD; however, it remains unclear which children with ASD respond to which type of intervention.

A randomized controlled trial of an inference generation strategy intervention for adults with high-functioning autism spectrum disorder.

PURPOSE: The present intervention study investigated the efficacy of the ACT & Check Strategy intervention to improve inference generation when reading, metacognitive ability, general reading comprehension, and social inference ability in adults with high-functioning autism spectrum disorder (HF-ASD). METHOD: Twenty-five adults with HF-ASD were randomly assigned to either a treatment or a control group. Treatment sessions were conducted in 1-hr sessions, twice a week, for a total of 6 weeks. Treatment focused on explicit instruction of components of inference generation, categories of inferences, and increasingly independent strategy use. RESULTS: The treatment group demonstrated significantly superior performance on 1 of 2 measures of inference generation in reading and 1 measure of metacognitive ability compared with the control group. Significant differences between groups were not found on measures of reading comprehension or social inference ability. CONCLUSION: These findings suggest that the ACT & Check Strategy was effective in improving participants' ability to generate inferences in reading and certain metacognitive abilities, but the skills do not appear to generalize to other social communication contexts, such as social inference generation. This research provides a measure of support for explicitly teaching inference generation to address a reading inference deficit in adults with HF-ASD.

Behavioral stuttering interventions for children and adolescents: a systematic review and meta-analysis.

PURPOSE: To evaluate the effectiveness of behavioral interventions designed to treat stuttering in children. METHOD: Studies were included for review if (a) the treatment was a behavioral intervention, (b) participants were between 2 and 18 years old, (c) the design was an experimental or quasi-experimental group design, and (d) the reported outcome measure assessed stuttering. An electronic search of 8 databases yielded a total of 9 studies, representing 327 treated participants across 7 different intervention types. Data were extracted for participant, treatment, and outcome characteristics as well as for methodological quality. RESULTS: An analysis of the treatment effects yielded significant positive effects approaching 1 SD when compared with a nontreatment control group. No significant differences emerged for studies comparing 2 different treatments. CONCLUSION: Conclusions drawn from the extant research suggest that data to support the efficacy of behavioral intervention in children exists for a limited number of intervention strategies, based on a meager number of methodologically acceptable studies.

Assessing methodological quality of randomized and quasi-experimental trials: a summary of stuttering treatment research.

The purpose of this study is to provide a detailed analysis of the methodological quality of experimental and quasi-experimental group designed studies in the area of stuttering intervention. A total of 23 randomized controlled trials (RCT) and quasi-experimental studies of treatment in the area of stuttering were identified and retrieved from an electronic search of nine databases and 13 individual journals. Using the Downs and Black Checklist each study was coded for reporting, external validity, internal validity, and internal validity confounding. Results of the coding indicated that while overall reporting was reasonably complete, the quality of the external and internal validity scores was found to be substantively incomplete. This lack of clarity and completeness of reporting issues related to the external and internal validity makes the interpretation of the findings of individual study results problematic and seriously effects the replicability of the individual study. Implications of these findings are suggested for both researchers and clinicians.

Botulinum toxin for treating spasmodic dysphonia (laryngeal dystonia): a systematic Cochrane review.

BACKGROUND: Spasmodic dysphonia is a neurological voice disorder characterized by involuntary adductor (towards midline) or abductor (away from midline) vocal fold spasms during phonation which result in phonatory breaks. Botulinum toxin is currently the gold standard of treatment. OBJECTIVE: To determine the efficacy of botulinum toxin therapy for the treatment of spasmodic dysphonia. DESIGN: Systematic Cochrane review. SEARCH STRATEGY: The search strategy for this review complied with Cochrane standards. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1966 to February 2005), EMBASE (1974 to February 2005), CINAHL (through February 2005), Dissertation Abstracts International (1975 to February 2005) and PsycINFO (1975 to February 2005). The search engine FirstSearch was also used (February 2005). Reference lists for all the obtained studies and other review articles were examined for additional studies. SELECTION CRITERIA: All randomized control trials where the participants were randomly allocated prior to intervention and in which botulinum toxin was compared to an alternative treatment, placebo or non-treated control group were included. DATA COLLECTION AND ANALYSIS: Two reviewers independently evaluated all potential studies meeting the selection criteria noted above for inclusion. MAIN RESULTS: Only one study in the literature met the inclusion criteria. This was the only study identified which reported a treatment/no treatment comparison. It reported significant beneficial effects for fundamental frequency (Fo), Fo range, spectrographic analysis, independent ratings of voice severity and patient ratings of voice improvement. REVIEWER'S CONCLUSIONS: The evidence from randomized controlled trials supporting the effectiveness of botulinum toxin for management of spasmodic dysphonia is deficient. The lack of supporting evidence from randomized controlled trials results in an inability to draw unbiased generalized conclusions regarding the effectiveness of botulinum toxin for all types of spasmodic dysphonia.

The efficacy of treatment for children with developmental speech and language delay/disorder: a meta-analysis.

A meta-analysis was carried out of interventions for children with primary developmental speech and language delays/disorders. The data were categorized depending on the control group used in the study (no treatment, general stimulation, or routine speech and language therapy) and were considered in terms of the effects of intervention on expressive and receptive phonology, syntax, and vocabulary. The outcomes used in the analysis were dependent on the aims of the study; only the primary effects of intervention are considered in this review. These were investigated at the level of the target of therapy, measures of overall linguistic development, and broader measures of linguistic functioning taken from parent report or language samples. Thirty-six articles reporting 33 different trials were found. Of these articles, 25 provided sufficient information for use in the meta-analyses; however, only 13 of these, spanning 25 years, were considered to be sufficiently similar to be combined. The results indicated that speech and language therapy might be effective for children with phonological or expressive vocabulary difficulties. There was mixed evidence concerning the effectiveness of intervention for children with expressive syntax difficulties and little evidence available considering the effectiveness of intervention for children with receptive language difficulties. No significant differences were found between interventions administered by trained parents and those administered by clinicians. The review identified longer duration (>8 weeks) of therapy as being a potential factor in good clinical outcomes. A number of gaps in the evidence base are identified.